| NPI | 1801089255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: AZ 244633) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 5136530-4405) |
| 363L00000X Nurse Practitioner (Licence: ID NP-828A) | |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2023-06-14 |